Some of the first efforts to use a woman’s natural tissue for breast reconstruction involved TRAM flaps, which draw much of their blood supply from vessels in the transverse rectus abdominis muscle.
Currently, there are two types of TRAM procedures, both of which involve taking fat, skin and muscle from the abdomen and moving it to the chest wall. When the TRAM flap is a pedicle flap, it remains attached to its blood supply, with the tissue surgically tunneled underneath the skin to the breast region. When the TRAM flap is a free flap, the tissue is detached and cut away from its blood supply before being transferred.
The TRAM pedicle procedures take about two hours at MUSC, while the free-flap procedure takes about three hours. Both require a four-day hospital stay.
Because muscle is removed from the abdomen via the TRAM flap, the affected area will be weaker than the surrounding tissues. As a result, a hernia is a common complication of this procedure. The DIEP flap also is taken from the abdomen but does not cause muscle loss, allowing for quicker recovery and greater strength in the abdominal region, making it a preferred option to the TRAM flap.
With both the TRAM and the DIEP procedure, you will have the added benefit of a tummy tuck as a result of the transfer.
The scars associated with the TRAM procedure will be located on your breast and abdomen. The scar on your breast is elliptical with some of the abdominal skin from the TRAM flap being visible. The abdominal scar runs horizontally from hip to hip along the panty line. In addition, there is a scar around the belly button.